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Chirurgia

（χειρουργία). Surgery; a word meaning literally
“handiwork.” The practice of surgery was at first considered by the
ancients to be merely a part of a physician's duty; but, as in later times the two branches of
the profession were to a great extent separated, it will perhaps be more convenient to treat
of it under a separate head. Without touching upon the disputed question, which is the more
ancient branch of the profession, or even trying to give such a definition of the word chirurgia as would be likely to satisfy both the physicians and the surgeons
of the present day, it will be sufficient to determine the sense in which the word was used by
the ancients; and then to give an account of this division of the science and art of medicine
as practised among the Greeks and Romans, referring to the article Medicina for further particulars.

The word chirurgia is derived from χείρ, “the hand,” and ἔργον,
“a work,” and is explained by Celsus (De Med. lib. vii.
Praefat.) to mean that part of medicine quae manu curat, “which
treats ailments by means of the hand”; in Diogenes Laertius (iii. 85) it is said to
cure διὰτοῦτέμνεινκαὶκαίειν, “by cutting
and burning.” Omitting the fabulous and mythological personages, Apollo,
Aesculapius, Chiron, etc., the only certain traditions respecting the state of surgery before
the establishment of the republics of Greece, and even until the time of the Peloponnesian
War, are to be found in the Iliad and Odyssey. There it appears
that surgery was almost entirely confined to the treatment of wounds, and the imaginary power
of enchantment was joined with the use of topical applications (Il. iii. 218). The Greeks received surgery, together with the other
branches of medicine, from the Egyptians; and from some observations made by the
archæologists who accompanied the French expedition to Egypt in 1798, and by
subsequent investigators, it appears that there are documents fully proving that in very
remote times this extraordinary people had reached a degree of proficiency of which few of the
moderns have any conception. Upon the ceilings and walls of the temples at Karnac, Luxor,
etc., bas-reliefs are seen, representing limbs that have been cut off with instruments very
similar to those which are employed for amputations at the present day. The same instruments
are again observed in the hieroglyphics, and vestiges of other surgical operations may be
traced, which afford convincing proofs of the skill of the ancient Egyptians in this branch of
medical science.

The earliest remaining surgical writings are those in the Hippocratic Collection, where
there are ten treatises on this subject, of which, however, only one is considered undoubtedly
genuine. Hippocrates (B.C. 460-357?) far surpassed all his predecessors in the boldness and
success of his operations; and though the scanty knowledge of anatomy possessed in those times
prevented his attaining any very great perfection, still one should rather admire his genius,
which enabled him to do so much, than blame him because, with his imperfect information, he
could not accomplish more. (See Hippocrates.)
The scientific skill in reducing fractures and luxations displayed in his works De
Fracturis, De Articulis, excites the admiration of Haller (Biblioth.
Chirurg.); and he was most probably the inventor of the ambe,
an old surgical machine for dislocations of the shoulder, which, though now fallen into
disuse, enjoyed for a long time a great reputation. In his work De Capitis
Vulneribus he gives minute directions about the time and mode of using the trephine,
and warns the operator against the probability of his being deceived by the sutures of the
cranium, as he confesses happened to himself (De Morb. Vulgar. lib. v. tom.
iii. p. 561, ed. Kühn). Amputation, in the modern sense of the word, is not described
in the Hippocratic Collection; though mention is made of the removal of a limb at the joint,
after the flesh has been completely destroyed by gangrene. The author of the
“Oath” commonly attributed to Hippocrates binds his pupils not to perform
the operation of lithotomy, but to leave it to persons specially accustomed to it (ἐργάτῃσιἀνδράσιπρήξιοςτῆσδε); from which it would
appear as if certain persons confined themselves to particular operations.

The names of several persons are preserved who practised surgery as well as medicine in the
times immediately succeeding those of Hippocrates; but, with the exception of some fragments,
inserted in the writings of Galen, Oribasius, Aëtius, etc., all their writings have
perished. Archagathus deserves to be mentioned, as he is said to have been the first foreign
surgeon who settled at Rome, B.C. 219 (Plin. H. N.
xxix. 12). He was at first very well received, the ius Quiritium was
conferred upon him, a shop was bought for him at the public expense, and he received the
honourable title of Vulnerarius; which, however, on account of his frequent use of the knife
and cautery, was soon changed by the Romans, who were unused to such a mode of practice, into
that of Carnifex. Asclepiades, who lived at the beginning of the first century B.C., is said
to have been the first person who proposed the operation of tracheotomy ( Aurel. De
Morb. Acut. i. 14.111; iii. 4.39). Ammonius of Alexandria, surnamed Λιθοτόμος, who is supposed to have lived rather later, is celebrated
in the annals of surgery for having been the first to propose and to perform the operation of
lithotrity, or breaking a calculus in the bladder when found to be too large for safe
extraction. Celsus has minutely described his mode of operating (De Med. vii.
26.3, p. 436), which in some respects resembles that of Civiale and Heurteloup in the early
part of the present century, and proves that, however much credit they may deserve for
perfecting the operation and bringing it out of oblivion into public notice, the praise of
having originally thought of it belongs to the ancients. “A hook or
crotchet,” says Celsus, “is fixed upon the stone in such a way as easily
to hold it firm, even when shaken, so that it may not revolve backward; then an iron
instrument is used, of moderate thickness, thin at the front end, but blunt, which, when
applied to the stone and struck at the other end, cleaves it: great care must be taken that
the instrument does not come into contact with the bladder itself, and that nothing fall upon
it by the breaking of the stone.” The next surgical writer after Hippocrates, whose
works are still extant, is Celsus, who lived at the beginning of the first century A.D., and
who has devoted the four last books of his work De Medicina, and especially the
seventh and eighth, entirely to surgical matter. It plainly appears from reading Celsus that
since the time of Hippocrates surgery had made very great progress, and had, indeed, reached a
high degree of perfection. We find in him the earliest mention of the use of the ligature for
the arrest of hemorrhage from wounded bloodvessels (v. 26.21, p. 262); and the Celsian mode of
amputation was continued down to comparatively modern times (vii. 33, p. 451). He is the first
author who gives directions for the operation of lithotomy (De Med. vii. 26.2,
p. 432), and the method described by him (called the apparatus minor, or
Celsus's method) continued to be practised till the commencement of the
sixteenth century. It was performed at Paris, Bordeaux, and other places in France, upon
patients of all ages, even as late as the latter part of the seventeenth century; and a modern
author (Allan On Lithotomy, p. 12) recommends it always to be preferred for boys under fourteen. He describes (vii. 25.3, p. 428) the operation of infibulatio, which was so commonly performed by the ancients upon singers,
etc., and is often alluded to in classical authors. (See Juv. vi. 73, 379; Seneca, in Lactant.
Divin. Instit. i. 16; Epigr. vii. 82, 1; Epigr. ix. 28, 12;
Epigr. xiv. 215, 1; Tertull. De Corona Mil.
11.) He also describes (vii. 25.1, p. 427) the operation of circumcision alluded to by St.
Paul (1 Cor.vii. 18). Paulus Aegineta (De Re
Med. vi. 53) transcribes from Antyllus a second method of performing the same
operation.

The following description by Celsus of the necessary qualifications of a surgeon deserves to
be quoted: “A surgeon,” says he (lib. vii. Praefat.), “ought to
be young, or, at any rate, not very old; his hand should be firm and steady, and never shake;
he should be able to use his left hand as readily as his right; his eyesight should be clear,
and his mind not easily startled; he should be so far subject to pity as to make him desirous
of the recovery of his patient, but not so far as to suffer himself to be moved by his cries;
he should neither hurry the operation more than the case requires, nor cut less than is
necessary, but do everything just as if the other's screams made no impression upon
him.”

Omitting Scribonius Largus, Moschion, and Soranus, the next author of importance is Caelius
Aurelianus, who is supposed to have lived about the beginning of the second century A.D., and
in whose works there is much surgical matter, but nothing that can be called original. He
rejected as absurd the operation of tracheotomy (De Morb. Chron. iii. 4.39). He
mentions a case of ascites that was cured by tapping (ib. iii. 8.128), and also a person who
recovered after being shot through the lungs by an arrow (ib. ii. 12.144).

Galen, the most voluminous and at the same time the most valuable medical writer of
antiquity, is less celebrated as a surgeon than as an anatomist and physician. He appears to
have practised surgery at Pergamus, but upon his removal to Rome (A.D. 165) he entirely
confined himself to medicine (De Meth. Med. vi. in fine,
tom. x. p. 455). His writings prove, however, that he did not entirely abandon surgery. His
Commentaries on the treatise of Hippocrates De Officina Medici, and his
treatise De Fasciis, show that he was well versed even in the minor details of
the art. He appears also to have been a skilful operator, though no great surgical inventions
are attributed to him.

Antyllus, who lived some time between Galen and Oribasius, is the earliest writer whose
directions for performing tracheotomy are still extant, though the operation (as stated above)
was proposed by Asclepiades about three hundred years before. Only a few fragments of the
writings of Antyllus remain, and among them the following passage is preserved by Paulus
Aegineta (De Re Med. vi. 33): “When we proceed to perform this
operation, we must cut through some part of the windpipe, below the larynx, about the third or
fourth ring; for to divide the whole would be dangerous. This place is commodious, because it
is not covered with any flesh, and because it has no vessels situated near the divided part.
Therefore, bending the head of the patient backward, so that the windpipe may come more
forward to the view, we make a transverse section between two of the rings, so that in
this case not the cartilage, but the membrane which unites the cartilages together, is
divided. If the operator be a little timid, he may first stretch the skin with a hook and
divide it; then, proceeding to the windpipe, and separating the vessels, if any are in the
way, he may make the incision.”

This operation appears to have been very seldom, if ever, performed by the ancients upon a
human being. Avenzoar tried it upon a goat, and found it might be done without much danger or
difficulty; but he says he should not like to be the first person to try it upon a man.

Oribasius, physician to the emperor Julian (A.D. 361), professes to be merely a compiler;
and though there is in his great work, entitled ΣυναγωγαὶἸατρικαί (Collecta Medicinalia), much surgical matter, there is
nothing original. The same may be said of Aëtius and Alexander Trallianus, both of
whom lived towards the end of the sixth century A.D. Paulus Aegineta has given up the fifth
and sixth books of his work De Re Medica entirely to surgery, and has inserted
much useful matter, derived in a great measure from his own observation and experience.
Albucasis translated into Arabic great part of these two books as the basis of his work on
surgery. Paulus was particularly celebrated for his skill in midwifery and female diseases,
and was called on that account, by the Arabians,
Al-Kawábelí, “the Accoucheur”
(Abulfaraj, Hist. Dynast. p. 181, ed. Pococke). He probably lived towards the
end of the seventh century A.D., and is the last of the ancient Greek and Latin medical
writers whose surgical works remain. The names of several others are recorded, but they are
not of sufficient eminence to require any notice here. For further information on the subject
both of medicine and surgery, see Medicina; and for
the legal qualifications, social rank, etc., both of physicians and surgeons, among the
ancient Greeks and Romans, see Medicus.

The surgical instruments from which the accompanying engravings (Nos. 1 to 19) are made were
found by a physician of St. Petersburg (Dr. Savenko) in 1819, at Pompeii, in the Via
Consularis (Strada Consulare), in a house which is supposed to have belonged to a surgeon.
They are now preserved in the museum at Portici. The engravings, with an account of them by
Dr. Savenko, were originally published in the Revue Médicale for
1821, vol. iii. p. 427, etc. They were afterwards inserted in Froriep's Notizen aus dem
Gebiete der Natur- und Heilkunde for 1822, vol. ii. n. 26, p. 57, etc. The
accompanying figures are copied from the German work, in which some of them appear to be badly
drawn. Their authenticity was at first doubted by Kühn (De Instrumentis
Chirurg. Veteribus Cognitis, et nuper Effossis, Leipzig, 1823), who thought they were
the same that had been described by Bayardi in his Catal. Antiq. Monument. Herculani
Effos. (Nap. 1754, fol., n. 236-294). When, however, his dissertation was afterwards
republished (Opusc. Academ. Med. et Philol., Leipzig, 1827, ii. 309), he
acknowledged himself to be completely satisfied on this point, and has given in the tract
referred to a learned and ingenious description of the instruments and their supposed uses,
from which the following account is chiefly abridged. It will, however, be seen at once that
the form of most of them is so simple, and their uses so obvious, that very little explanation
is necessary. Altogether they give a very high idea of both the science and
the practice of surgery among the Romans.

1, 2. Two probes (specillum, μήλη）
made of iron; the larger six inches long, the smaller four and a half. 3. A cautery (καυτήριον) made of iron, rather more than four inches long. 4, 5. Two
lancets (scalpellum, σμίλη) made of
copper; the former two inches and a half long, the other three inches. It seems doubtful
whether they were used for blood-letting or for opening abscesses, etc. 6. A knife, apparently
made of copper, the blade of which is two inches and a half long, and in the broadest part one
inch in breadth; the back is straight and thick, and the edge much curved; the handle is so
short that Savenko thinks it must have been broken. It is uncertain for what particular
purpose it was used: Kühn conjectures that (if it be a surgical instrument at all) it
may have been made with such a curved edge and such a straight thick back in order that it
might be struck with a hammer, and so amputate fingers, toes, etc. 7. Another knife,
apparently

Surgical Instruments.

made of copper, the blade of which is of a triangular shape, two inches long, and in
the broadest part eight lines in breadth; the back is straight and one line broad, and this
breadth continues all the way to the point, which, therefore, is not sharp, but guarded by a
sort of button. Kühn thinks it may have been used for enlarging wounds, etc., for
which it would be particularly fitted by its blunt point and broad back. 8. A needle, about
three inches long, made of iron. 9. An elevator (or instrument for raising depressed portions
of the skull), made of iron, five inches long, and very much resembling those made use of at
the present day. 10-14. Different kinds of forceps (volsellae). No. 10
has the two sides separated from each other, and is five inches long. No. 11 is also five
inches long. No. 12 is three inches and a half long. The sides are narrow at the point of
union, and become broader by degrees towards the other end, where, when closed, they would
form a kind of arch. It should be noticed that it is furnished with a movable ring, exactly
like the tenaculum forceps employed at the present day. No. 13 was used for pulling out hairs
by the roots (τριχολαβίς). No. 14 is six inches long, and is
bent in the middle. It was probably used for extracting foreign bodies that had stuck in the
œsophagus, or gullet, or in the bottom of a wound. 15. A male catheter (aenea fistula), nine inches in length.

Surgical Instruments.

The shape is remarkable from its having the double curve like the letter S, which is
the form that was re-invented in the last century by the celebrated French surgeon J. L.
Petit. 16. Probably a female catheter, four inches in length. Celsus describes both male and
female catheters (De Med. vii. 26.1, p. 429). 17. Supposed by Froriep to be an
instrument for extracting teeth (ὀδοντάγρα, Pollux, iv.
181); but Kühn, with much more probability, conjectures it to be an instrument used
in amputating part of an enlarged uvula, and quotes Celsus (De Med. vii. 12.3,
p. 404), who says that “no method of operating is more convenient than to

Surgical Instruments.

take hold of the uvula with the forceps, and then to cut off below it as much as is
necessary.” 18, 19. Probably two spatulae. Nos. 20-23 are perhaps the most
interesting of all, as showing the means employed by the Romans in the exploration of some of
the internal cavities of the body, for the discovery and treatment of disease. They are taken
from Bened. Vulpi, Illustraz. di tutti gli Strumenti Chirurgici, etc.
(Naples, 1847), Mem. 4, p. 39, etc., where there is a
detailed and learned description of them. Nos. 20, 21 are two views of the same kind of
instrument—viz., a dilator vaginae (διόπτρα, Aegin. Paul. vi. 73). No. 22 is a dilator ani
(ἑδροδιαστολεύς, id. vi. 78); and No. 23, nippers for
compressing veins or extracting splintered bones.